Volume 14 Issue 1
Jan.  2023
Turn off MathJax
Article Contents
Article Navigation >  ORGAN TRANSPLANTATION  > 2023  >  14(1): 106-112
Chen Siyao, Wu Min, Huang Jinsong, et al. Risk factors and predictive analysis of hyperkalemia after heart transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 106-112. doi: 10.3969/j.issn.1674-7445.2023.01.014
Citation: Chen Siyao, Wu Min, Huang Jinsong, et al. Risk factors and predictive analysis of hyperkalemia after heart transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 106-112. doi: 10.3969/j.issn.1674-7445.2023.01.014
shu

Risk factors and predictive analysis of hyperkalemia after heart transplantation

doi: 10.3969/j.issn.1674-7445.2023.01.014

  • Department of Cardiac Surgery Intensive Care Unit, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510080, China

More Information
  • Corresponding author: Wu Yijin, Email: wuyijin@gdph.org.cn
  • Received Date: 2022-08-26
    Available Online: 2023-01-17
  • Publish Date: 2023-01-15
    Abstract
  •   Objective  To analyze clinical prognosis, risk factors and predictive indexes of hyperkalemia in recipients after heart transplantation.  Methods  Clinical data of 158 recipients were retrospectively analyzed. According to the serum potassium levels within postoperative 1-year follow-up, all recipients were divided into the normal serum potassium level group (n=83), hyperkalemia group (n=43) and severe hyperkalemia group (n=32). The incidence and prognosis of hyperkalemia after heart transplantation were summarized. The risk factors and predictive indexes of hyperkalemia after heart transplantation were identified.  Results  The incidence of hyperkalemia and severe hyperkalemia within postoperative 1 year was 47.5%(75/158) and 20.3%(32/158), respectively. In the severe hyperkalemia group, the fatality was 16%(5/32), higher than 8%(7/83) in the normal serum potassium level group and 7%(3/43) in the hyperkalemia group. The mean serum creatinine (Scr) within 6 months before heart transplantation, the final total bilirubin level before heart transplantation, postoperative hemodialysis time, the Scr level and N-terminal pro-brain natriuretic peptide level at postoperative 1 d were the independent risk factors for hyperkalemia following heart transplantation (all P < 0.05). The mean Scr level within 6 months before heart transplantation, postoperative hemodialysis time, and Scr levels at postoperative 1 and 7 d could be used to predict postoperative severe hyperkalemia.  Conclusions  The recipients with severe hyperkalemia after heart transplantation obtain poor prognosis. The mean Scr level within 6 months before heart transplantation, the final total bilirubin level before heart transplantation, postoperative hemodialysis time, and the Scr level and N-terminal pro-brain natriuretic peptide level at postoperative 1 d are the independent risk factors for hyperkalemia after heart transplantation. Perioperative Scr level and postoperative hemodialysis time may be used to predict the incidence of severe hyperkalemia within 1 year after heart transplantation.

     

    • FullText(HTML)
  • loading
    • References(38)
  • [1]
    SINGH J, KICHLOO A, VIPPARLA N, et al. Hyperkalemia: major but still understudied complication among heart transplant recipients[J]. World J Transplant, 2021, 11(6): 203-211. DOI: 10.5500/wjt.v11.i6.203.
    [2]
    URIEL M, HOLZHAUSER L, NGUYEN A, et al. Incidence and clinical significance of hyperkalemia following heart transplantation[J]. Transplant Proc, 2021, 53(2): 673-680. DOI: 10.1016/j.transproceed.2020.11.002.
    [3]
    PALMER BF, CARRERO JJ, CLEGG DJ, et al. Clinical management of hyperkalemia[J]. Mayo Clin Proc, 2021, 96(3): 744-762. DOI: 10.1016/j.mayocp.2020.06.014.
    [4]
    ZHAO R, HAO X, WANG F, et al. The characteristic and dynamic electrocardiogram changes on hyperkalemia in a hemodialysis patient with heart failure: a case report[J]. J Geriatr Cardiol, 2022, 19(2): 163-166. DOI: 10.11909/j.issn.1671-5411.2022.02.010.
    [5]
    WAGENER G, BEZINOVER D, WANG C, et al. Fluid management during kidney transplantation: a consensus statement of the Committee on Transplant Anesthesia of the American Society of Anesthesiologists[J]. Transplantation, 2021, 105(8): 1677-1684. DOI: 10.1097/TP.0000000000003581.
    [6]
    LONG B, WARIX JR, KOYFMAN A. Controversies in management of hyperkalemia[J]. J Emerg Med, 2018, 55(2): 192-205. DOI: 10.1016/j.jemermed.2018.04.004.
    [7]
    SARNOWSKI A, GAMA RM, DAWSON A, et al. Hyperkalemia in chronic kidney disease: links, risks and management[J]. Int J Nephrol Renovasc Dis, 2022, 15: 215-228. DOI: 10.2147/IJNRD.S326464.
    [8]
    GUPTA AA, SELF M, MUELLER M, et al. Dispelling myths and misconceptions about the treatment of acute hyperkalemia[J]. Am J Emerg Med, 2022, 52: 85-91. DOI: 10.1016/j.ajem.2021.11.030.
    [9]
    WETMORE JB, YAN H, PENG Y, et al. Development and outcomes of hyperkalemia in hospitalized patients: potential implications for care[J]. Am Heart J, 2021, 241: 59-67. DOI: 10.1016/j.ahj.2021.07.006.
    [10]
    RAEBEL MA. Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers[J]. Cardiovasc Ther, 2012, 30(3): e156-e166. DOI: 10.1111/j.1755-5922.2010.00258.x.
    [11]
    ALMALKI B, CUNNINGHAM K, KAPUGI M, et al. Management of hyperkalemia: a focus on kidney transplant recipients[J]. Transplant Rev (Orlando), 2021, 35(2): 100611. DOI: 10.1016/j.trre.2021.100611.
    [12]
    RIZK JG, LAZO JG JR, QUAN D, et al. Mechanisms and management of drug-induced hyperkalemia in kidney transplant patients[J]. Rev Endocr Metab Disord, 2021, 22(4): 1157-1170. DOI: 10.1007/s11154-021-09677-7.
    [13]
    BUSSALINO E, PANARO L, MARSANO L, et al. Prevalence and clinical correlates of hyperkalemia in stable kidney transplant recipients[J]. Intern Emerg Med, 2021, 16(7): 1787-1792. DOI: 10.1007/s11739-021-02649-4.
    [14]
    PARK S, KANG E, PARK S, et al. Metabolic acidosis and long-term clinical outcomes in kidney transplant recipients[J]. J Am Soc Nephrol, 2017, 28(6): 1886-1897. DOI: 10.1681/ASN.2016070793.
    [15]
    POCHINENI V, RONDON-BERRIOS H. Electrolyte and acid-base disorders in the renal transplant recipient[J]. Front Med (Lausanne), 2018, 5: 261. DOI: 10.3389/fmed.2018.00261.
    [16]
    LITTMANN L, GIBBS MA. Electrocardiographic manifestations of severe hyperkalemia[J]. J Electrocardiol, 2018, 51(5): 814-817. DOI: 10.1016/j.jelectrocard.2018.06.018.
    [17]
    傅强, 付晓华, 李志樑, 等. 射血分数保留性心力衰竭合并终末期肾病不同透析方式下疗效对比[J]. 实用医学杂志, 2020, 36(23): 3222-3226. DOI: 10.3969/j.issn.1006-5725.2020.23.011.

    FU Q, FU XH, LI ZL, et al. Comparison of therapeutic effects of ESRD with HFpEF under different dialysis methods[J]. J Pract Med, 2020, 36(23): 3222-3226. DOI: 10.3969/j.issn.1006-5725.2020.23.011.
    [18]
    TEYMOURI N, MESBAH S, NAVABIAN SMH, et al. ECG frequency changes in potassium disorders: a narrative review[J]. Am J Cardiovasc Dis, 2022, 12(3): 112-124.
    [19]
    BOBBIO E, BOLLANO E, POLTE CL, et al. Association between central haemodynamics and renal function in advanced heart failure: a nationwide study from Sweden[J]. ESC Heart Fail, 2022, 9(4): 2654-2663. DOI: 10.1002/ehf2.13990.
    [20]
    CHEN JW, CHOU NK, WANG CH, et al. Impact of pretransplant renal replacement therapy on clinical outcome after isolated heart transplantation[J]. Transpl Int, 2022, 35: 10185. DOI: 10.3389/ti.2022.10185.
    [21]
    HONG KN, MERLO A, CHAUHAN D, et al. Evidence supports severe renal insufficiency as a relative contraindication to heart transplantation[J]. J Heart Lung Transplant, 2016, 35(7): 893-900. DOI: 10.1016/j.healun.2016.02.003.
    [22]
    HUNTER RW, BAILEY MA. Hyperkalemia: pathophysiology, risk factors and consequences[J]. Nephrol Dial Transplant, 2019, 34(Suppl 3): iii2-iii11. DOI: 10.1093/ndt/gfz206.
    [23]
    WANG G, MA K, MA Z, et al. Short-term blood pressure variability and outcomes in non-dialysis chronic kidney disease[J]. Front Med (Lausanne), 2022, 9: 911205. DOI: 10.3389/fmed.2022.911205.
    [24]
    PATA R, LUTAYA I, MEFFORD M, et al. Urinary tract infection causing bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia (BRASH) syndrome: a case report and a brief review of the literature[J]. Cureus, 2022, 14(8): e27641. DOI: 10.7759/cureus.27641.
    [25]
    LINDNER G, BURDMANN EA, CLASE CM, et al. Acute hyperkalemia in the emergency department: a summary from a Kidney Disease: Improving Global Outcomes conference[J]. Eur J Emerg Med, 2020, 27(5): 329-337. DOI: 10.1097/MEJ.0000000000000691.
    [26]
    PALMER BF. Potassium binders for hyperkalemia in chronic kidney disease-diet, renin-angiotensin-aldosterone system inhibitor therapy, and hemodialysis[J]. Mayo Clin Proc, 2020, 95(2): 339-354. DOI: 10.1016/j.mayocp.2019.05.019.
    [27]
    GILLIGAN S, RAPHAEL KL. Hyperkalemia and hypokalemia in CKD: prevalence, risk factors, and clinical outcomes[J]. Adv Chronic Kidney Dis, 2017, 24(5): 315-318. DOI: 10.1053/j.ackd.2017.06.004.
    [28]
    LEON SJ, WHITLOCK R, RIGATTO C, et al. Hyperkalemia-related discontinuation of renin-angiotensin-aldosterone system inhibitors and clinical outcomes in CKD: a population-based cohort study[J]. Am J Kidney Dis, 2022, 80(2): 164-173. DOI: 10.1053/j.ajkd.2022.01.002.
    [29]
    SANTORO A, PERRONE V, GIACOMINI E, et al. Association between hyperkalemia, RAASi non-adherence and outcomes in chronic kidney disease[J]. J Nephrol, 2022, 35(2): 463-472. DOI: 10.1007/s40620-021-01070-6.
    [30]
    VOLTERRANI M, PERRONE V, SANGIORGI D, et al. Effects of hyperkalaemia and non-adherence to renin-angiotensin-aldosterone system inhibitor therapy in patients with heart failure in Italy: a propensity-matched study[J]. Eur J Heart Fail, 2020, 22(11): 2049-2055. DOI: 10.1002/ejhf.2024.
    [31]
    RICCIO E, CAPUANO I, BUONANNO P, et al. RAAS inhibitor prescription and hyperkalemia event in patients with chronic kidney disease: a single-center retrospective study[J]. Front Cardiovasc Med, 2022, 9: 824095. DOI: 10.3389/fcvm.2022.824095.
    [32]
    IMAMURA T, NARANG N, COMBS P, et al. Hyperkalemia in patients with left ventricular assist devices[J]. Circ Rep, 2021, 3(11): 647-653. DOI: 10.1253/circrep.CR-21-0078.
    [33]
    MEZZANO G, CÁRDENAS A, AGUILAR F, et al. Hyperkalemia influences the outcome of patients with cirrhosis with acute decompensation (AD) and acute-on-chronic liver failure (ACLF)[J]. Dig Liver Dis, 2021, 53(6): 738-745. DOI: 10.1016/j.dld.2020.12.009.
    [34]
    GRODZINSKY A, GOYAL A, GOSCH K, et al. Prevalence and prognosis of hyperkalemia in patients with acute myocardial infarction[J]. Am J Med, 2016, 129(8): 858-865. DOI: 10.1016/j.amjmed.2016.03.008.
    [35]
    GOYAL A, SPERTUS JA, GOSCH K, et al. Serum potassium levels and mortality in acute myocardial infarction[J]. JAMA, 2012, 307(2): 157-164. DOI: 10.1001/jama.2011.1967.
    [36]
    FISCHER B, SERRA A, TELSER H. Cost-effectiveness of treating patients with chronic kidney disease and prior hyperkalemia with renin-angiotensin-aldosterone system inhibitor and patiromer: a Swiss public healthcare perspective[J]. Adv Ther, 2022, 39(6): 2717-2730. DOI: 10.1007/s12325-022-02123-3.
    [37]
    WIDÉN J, IVARSSON M, SCHALIN L, et al. Cost-effectiveness analysis of patiromer in combination with renin-angiotensin-aldosterone system inhibitors for chronic kidney disease in Sweden[J]. Pharmacoeconomics, 2020, 38(7): 747-764. DOI: 10.1007/s40273-020-00902-w.
    [38]
    WARD T, BROWN T, LEWIS RD, et al. The cost effectiveness of patiromer for the treatment of hyperkalaemia in patients with chronic kidney disease with and without heart failure in Ireland[J]. Pharmacoecon Open, 2022, 6(5): 757-771. DOI: 10.1007/s41669-022-00357-z.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(2)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (261) PDF downloads(84) Cited by()
    Proportional views
    Related

    WeChat Subscription Account

    Wechat Service Account

    Contact Us
    • Tel：020-38736410
    • Email: organtranspl@163.com
    • Address：The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou
    • Editorial Office of Organ Transplantation  粤ICP备2021030844号
    Links

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return